Utilization Management Nurse Manager

Join a compassionate team dedicated to prioritizing health! The Utilization Management Nurse Manager will report to the Associate Director of Care Management. In this role, you will leverage your clinical nursing expertise to ensure the effective coordination, documentation, and communication of medical services and benefits. As the Manager of Utilization Management Nursing, you will work within established guidelines, applying your advanced technical skills to navigate moderately complex challenges while independently shaping methods, resources, schedules, and objectives aligned with assigned goals. Apply your clinical knowledge to interpret criteria and procedures, ensuring optimal treatment and care for our Members. Lead and supervise the physical health Utilization Management team, overseeing daily operations efficiently. Participate in hiring, coaching, counseling, and evaluating the performance of your direct reports. Implement and sustain processes that align with Michigan Department of Health and Human Services (MDHHS) and National Committee for Quality Assurance (NCQA) standards. Collaborate with UM leadership to identify inefficiencies and propose innovative solutions to enhance clinical outcomes. Gather and analyze data to inform operational metrics and performance improvements. Facilitate communication among Providers, Members, and other stakeholders to enable seamless care and treatment. Make strategic decisions regarding resources, approaches, and tactical operations within your department's projects. Promote cross-departmental collaboration and lead briefings and meetings, maintaining regular contact with other managers. Make a meaningful impact with your expertise! Required Qualifications Bachelor's Degree 2+ years of management experience Licensed Registered Nurse (RN) in Michigan with a clean disciplinary record Previous experience in utilization management. Experience leading interdisciplinary teams, fostering an environment of accountability, professional development, and quality service within long-term services and supports (LTSS). 1+ years of experience in LTSS programs, with knowledge of Medicaid waivers, care coordination, and eligibility requirements. Progressive clinical experience in acute care, skilled nursing, or rehabilitation settings. Proven ability to work both independently and collaboratively within interdisciplinary care teams, including social workers, nurses, and allied health professionals. Preferred Qualifications Experience in Health Plans Prior Medicare/Medicaid experience Clinical experience in LTSS settings, such as home health, hospice, nursing facilities, or adult day services, with an emphasis on supporting individuals with disabilities and aging adults. Experience in call centers or triage. Bilingual skills are a plus. Additional Information This position is fully remote, with occasional travel required to Humana's offices for training or meetings. Weekly Hours 40 Compensation Range $94,900 - $130,500 per year, plus eligibility for a bonus incentive plan based on individual and company performance. Benefits Humana offers a comprehensive benefits package to support your overall well-being. Our benefits include medical, dental, and vision coverage, a 401(k) retirement savings plan, generous paid time off, short-term and long-term disability plans, life insurance, and more. About Humana Humana Inc. is committed to prioritizing health for our employees, customers, and the communities we serve. Our integrated healthcare services aim to simplify access to care, ensuring our members achieve optimal health and quality of life. Equal Opportunity Employer Humana is dedicated to ensuring equal employment opportunities for all applicants and employees. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, or veteran status. We actively promote diversity and inclusivity within our workforce.

Created: 2026-03-07